The sensitivity and specificity of the mannitol bronchial challenge test to identify asthma in different populations: a systematic review.
- Kernen P University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.
- Steveling-Klein EH Allergy Unit, Department of Dermatology, University Hospital Basel, Switzerland.
- Saccilotto RT Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital and University of Basel, Switzerland.
- Raatz H Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital and University of Basel, Switzerland.
- Briel M Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital and University of Basel, Switzerland / Medical Faculty, University of Basel, Switzerland.
- Koller MT Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital and University of Basel, Switzerland / Medical Faculty, University of Basel, Switzerland.
- Westwood M Kleijnen Systematic Reviews Ltd, York, United Kingdom.
- Bucher HC Allergy Unit, Department of Dermatology, University Hospital Basel, Switzerland / Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital and University of Basel, Switzerland / Medical Faculty, University of Basel, Switzerland.
- Miedinger D University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland / Medical Faculty, University of Basel, Switzerland.
- Leuppi JD University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland / Medical Faculty, University of Basel, Switzerland.
- 2019-09-03
Published in:
- Swiss medical weekly. - 2019
Adolescent
Adult
Aged
Aged, 80 and over
Asthma
Bronchial Provocation Tests
Child
Diagnostic Tests, Routine
Female
Humans
Male
Mannitol
Middle Aged
Sensitivity and Specificity
Young Adult
English
OBJECTIVE
Asthma is associated with bronchial hyperresponsiveness, assessed by bronchial provocation tests such as the mannitol test. We aimed to assess the data on sensitivity and specificity of the mannitol test in diagnosing asthma.
DATA SOURCES
We searched electronically the Medline, Embase and Central databases from 1997 to 2019.
STUDY SELECTION
Inclusion criteria were the assessment of the validity of the mannitol test. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). Data were extracted according to a prespecified list and analysed qualitatively.
RESULTS
A total of 27 studies (4589 individuals, age 6–85 years, cross-sectional [n = 18] and case-controlled [n = 9] study design) were included. Overall sensitivity and specificity ranged from 8% (95% confidence interval [CI] 1–27) to 100% (95% CI 93–100) and 75% (95% CI 67–82) to 100% (95% CI 85–100). Excluding case-controlled design, studies conducted in a clinical setting showed a range from 19% (95% CI 14–27) to 91% (95% CI 59–100) for sensitivity and from 75% (95% CI 67–82) to 100% (95% CI 80–100) for specificity. Heterogeneity was high owing to differences in the populations examined and the methods used.
CONCLUSIONS
Studies on the accuracy of the mannitol test were heterogeneous. Overall specificity was higher than sensitivity and therefore the mannitol test seems to be a suitable diagnostic tool to confirm asthma. However, the high level of heterogeneity among the included studies makes a conclusive statement on the accuracy of the mannitol test difficult and further research is needed. As bronchial provocation tests can be especially useful in patients with an intermediate probability of asthma diagnosis, further studies are needed that include subjects with asthma symptoms but intermediate probability of asthma diagnosis.
Asthma is associated with bronchial hyperresponsiveness, assessed by bronchial provocation tests such as the mannitol test. We aimed to assess the data on sensitivity and specificity of the mannitol test in diagnosing asthma.
DATA SOURCES
We searched electronically the Medline, Embase and Central databases from 1997 to 2019.
STUDY SELECTION
Inclusion criteria were the assessment of the validity of the mannitol test. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). Data were extracted according to a prespecified list and analysed qualitatively.
RESULTS
A total of 27 studies (4589 individuals, age 6–85 years, cross-sectional [n = 18] and case-controlled [n = 9] study design) were included. Overall sensitivity and specificity ranged from 8% (95% confidence interval [CI] 1–27) to 100% (95% CI 93–100) and 75% (95% CI 67–82) to 100% (95% CI 85–100). Excluding case-controlled design, studies conducted in a clinical setting showed a range from 19% (95% CI 14–27) to 91% (95% CI 59–100) for sensitivity and from 75% (95% CI 67–82) to 100% (95% CI 80–100) for specificity. Heterogeneity was high owing to differences in the populations examined and the methods used.
CONCLUSIONS
Studies on the accuracy of the mannitol test were heterogeneous. Overall specificity was higher than sensitivity and therefore the mannitol test seems to be a suitable diagnostic tool to confirm asthma. However, the high level of heterogeneity among the included studies makes a conclusive statement on the accuracy of the mannitol test difficult and further research is needed. As bronchial provocation tests can be especially useful in patients with an intermediate probability of asthma diagnosis, further studies are needed that include subjects with asthma symptoms but intermediate probability of asthma diagnosis.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.4414/smw.2019.20100
- PMID 31476241
- Persistent URL
- https://sonar.ch/global/documents/170875
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